CONSULTATIVE PROCESSES IN HEALTH POLICY IN THE UNITED KINGDOM: A VIEW FROM THE CENTRE

Health policy at national level is the product of a series of continuous and complex interactions between interest groups operating both inside and outside government. It is generally thought that these consultative processes are closed, elitist and dominated by the prestigious medical specialties. Yet there has been a rapid growth in the number of groups representing various interests, professions and care groups. Drawing on recent examples from the national health service, the paper explores the extent to which consultative processes in health policy have remained closed or have been opened up to new influences. The analysis suggests that consultation within the health department is more pluralistic than is usually appreciated. Also, while the closed, elitist mode of consultation with external interests has been eroded marginally, it remains more or less intact. Nevertheless, the ability of powerful medical interests to get their own way to the exclusion of other interests depends on the resources and sanctions available to other groups and on the particular policy issue. It can no longer just be assumed.     

CHANGING THE DECISION SPACE: EUROPEAN POLICY INFLUENCES ON ENERGY POLICY AND SYSTEMS CHANGE IN SWEDEN

The EU takes a growing interest in governing the energy sector in its member states. Competing with national institutions, policies and organizational structures, it is however not clear whether the EU exerts a strong influence compared to other factors, and if there is such an influence, the mechanisms are not well understood. This paper examines strategic reorientation towards electricity investment in the Swedish energy sector, a ‘frontrunner case’ of Europeanization, and discusses how this change can be attributed to EU policy change, national policy change and organizational field developments respectively. It finds that EU energy policy influence has been notable, and that governance mechanisms that shape beliefs and expectations are strongly at play. However, despite growing EU clout on energy policy, field level and national policy change remain key drivers of the changing decision space in the examined time period.     

RESTRUCTURING WEBERIAN BUREAUCRACY: COMPARING MANAGERIAL REFORMS IN EUROPE AND THE UNITED STATES

In much of the international public administration literature, New Public Management (NPM) already appears to be bogged down in a quagmire of critical revisions and assessments. Although some criticisms are well founded, there can be no doubt that NPM represents a trend which has considerably affected public‐sector decision‐making worldwide. This article takes the examples of the Southern European bureaucracies, where NPM‐inspired reforms were introduced later than in the English‐speaking world, but have nevertheless played a decisive role in the political agenda of both socialist and conservative governments. The paper presents the results of a comparative study of administrative reforms in five European countries as well as the USA during the 1980s and 1990s. The comparison is based on three specific dimensions (central bureaucracies’ formal structure; civil service organization; administrative processes), enabling us to systematically measure and compare the progress of the various countries subsequent to the cycle of managerial reforms.     

TERRITORIAL PUBLIC EXPENDITURE IN THE UNITED KINGDOM

Although the devolution plans of the 1970s were abandoned, those debates had far-reaching consequences for the determination of relative public expenditure levels in the United Kingdom. The Barnett formula (10:5:85) of 1978 provided that increases in public expenditure in Scotland and in Wales for specific services within the territorial blocks would be determined according to the formula consequences of changes in equivalent English expenditure. A parallel formula allocated 2.75 per cent of the change in equivalent expenditure in Great Britain to Northern Ireland. The essential distinction is between base expenditure (whose current levels are carried forward) and incremental expenditure (which is determined by formula). The predicted convergence of block expenditure relatives on the LJK per capita average was frustrated by formula bypass, and in Scotland by relative population decline. The background to the 1992 recalibration of the Barnett formula (10.66:6.02100.00 and Northern Ireland 2.87 per cent) is analysed. Territorial block expenditure is set within the structure of territorial public expenditure aggregates, and evidence is assembled on identifiable public expenditure relatives between countries and by English region.     

THE EUROPEANIZATION OF HEALTH CARE GOVERNANCE: IMPLEMENTING THE MARKET IMPERATIVES OF EUROPE

The paper examines the Europeanization process and the impact of the European Union (EU) on national healthcare policies, using the example of Denmark. The analysis reveals that although health policy formally falls within the competence of member states, the impact of the EU is becoming increasingly conspicuous and has contributed to a gradual restructuring of healthcare boundaries as well as of some of its organizing principles. Furthermore, the process and impact have a de‐structuring effect on the more traditional governance tools used in relation to healthcare. The paper concludes that the EU has a significant impact and that we may be witnessing the formation of a new institutional legacy that represents the initiation of a Europeanized healthcare model: a model emerging around a new set of stakeholders, principles and structures, which includes the market, principles of free movement, patient choice and patient rights institutionalized and safeguarded by the EU.     

PATH DEPENDENCY AND INSTITUTIONAL CHANGE: THE CASE OF INDUSTRIAL EMISSION CONTROL IN SWEDEN

Theory‐independent measures of institutional change can be developed by identifying and tracking changes in institutional reproduction mechanisms. Such measures can then be used to assess the empirical validity of theoretical models of institutional change. This article performs an analysis of reproduction mechanisms in a case study of a Swedish institution for emission control during the period 1960–2000. The analysis reveals the existence of a highly path dependent institutional development, powerful enough to withstand a wide‐ranging institutional reform implemented in the late 1990s. The case study supports a gradualist model over a punctuated equilibrium model of institutional change, but the analysis also demonstrates the need for path dependency theory to pay greater attention to the question of how micro‐level institutional interaction generates aggregate patterns of change and stability.     

POLITICAL RECRUITMENT BEYOND ELECTIONS: AN EXPLORATION OF THE LINKAGE BETWEEN PATRONAGE,DEMOCRACY, AND DIVERSITY IN THE UNITED KINGDOM

Flowing out of wider debates regarding representative democracy, the diversity of political institutions has gained salience. Normatively, it is suggested that it is simply unfair for white, middle‐aged males to dominate decision‐making structures. Instead it has been argued that representative diversity can enhance the legitimacy of political institutions and processes, whilst improving the quality and inclusivity of policy‐making. Although most of these arguments have been applied to elected institutions and their bureaucracies, they are also germane in the context of appointments to the boards of public bodies, as the work of these bodies and the decisions made by their board members impacts upon the everyday lives of citizens. Drawing upon original research conducted in the UK, this article argues that the capacity of political actors to make appointments to public boards offers an as yet unrealized democratic potential by offering more opportunities for social engagement and participation in public governance.     

IMPLEMENTING PERFORMANCE APPRAISAL REFORM IN THE UNITED STATES CIVIL SERVICE

The 1978 US Civil Service Reform Act required federal agencies to design and implement new performance appraisal systems. The CSRA intends that these reformed systems produce accurate ratings which may be used as the basis for a wide variety of personnel actions, including decisions regarding pay, promotion, and retention. In this article, we describe and analyze the responses of civilian employees at four Navy research and development laboratories where CSRA appraisal systems have been in operation since 1981. These data were obtained through questionnaires and on-site interviews. Overall, reactions to the CSRA systems were supportive. However, signs of potentially serious long term problems may be appearing in the form of supervisory resistance to the significantly increased workload and potential for conflict associated with the new procedures. Recent changes in Office of Personnel Management policy suggest that this is a problem throughout the federal bureaucracy. The administrative-organizational'costs' of CSRA appraisals and radically changed political priorities are likely to present formidable barriers to the complete implementation of the CSRA.     

IMPLEMENTING EU NATURA 2000 AT THE PROJECT LEVEL: LESSONS FROM THE VELUWE BORDER LAKES IN THE NETHERLANDS

The implementation of the European Union Bird and Habitat Directives in the field of water infrastructure has caused severe project disruptions in the past. The prevalence of negative experience has triggered a new approach, which aims to integrate site‐specific characteristics of ecosystem and project objectives during the development of the initial project design. This is termed integrated nature design. In this paper we advance the hypothesis that applying integrated nature design in Natura 2000 areas can increase the chances of a project being approved in case appeal is made to the courts. To test our hypothesis we have carried out a quasi‐experimental comparison of two coastal zone development projects in the Netherlands. Our analysis demonstrates that a coastal development project in a Natura 2000 area has a greater chance of success if its design integrates nature, provided that the project administration and scientific findings are favourable.     

PRESENTATIONAL MANAGEMENT AND THE PURSUIT OF REGULATORY LEGITIMACY: A COMPARATIVE STUDY OF COMPETITION AND CONSUMER AGENCIES IN THE UNITED KINGDOM AND AUSTRALIA

Independent regulatory agencies, faced with multiple and often conflicting demands from regulatory stakeholders, yet operating at arm's length from government, may be under considerable pressure to demonstrate the legitimacy of their decisions and the regime they administer. This article considers how regulators employ presentational strategies to establish and maintain their legitimacy by documenting the findings of a comparative study of two independent agencies responsible for the regulation of trade practices in their respective jurisdictions: the UK Office of Fair Trading and the Australian Competition and Consumer Commission. Its findings demonstrate that presentational activities may be an important means by which regulators give concrete expression to their obligations of transparency, promote the effectiveness of the regime they administer, and publicly demonstrate how their work serves the community. The mass media is relied upon by both agencies as the primary vehicle through which they seek to communicate to their targeted audiences and the public at large, actively seeking to manage the ambivalence that infuses the regulatory enterprise.     

THE CENTRE STRIKES BACK: META‐GOVERNANCE,DELEGATION, AND THE CORE EXECUTIVE IN THE UNITED KINGDOM, 2010–14

A growing literature on ‘agencification’, ‘quangocratization’, and the ‘autonomization’ of the state has highlighted a coordination dilemma in contemporary public governance whereby governments rely on delegated governance but are frustrated by the lack of control that arises from such structures. In the run‐up to the 2010 General Election in the United Kingdom this coordination dilemma was prominent as the capacity of the Cabinet Office to exert control over arm's‐length bodies, either directly or indirectly, received intense criticism. This article presents the findings of the first detailed research project to examine the subsequent Coalition Government's approach to this dilemma. It argues that in relation to the governance of public bodies, the role and capacity of the Cabinet Office has been transformed. In mapping this development the article explores the implications of the centre striking back in the context of ‘post‐New Public Management’ reforms.     

PUBLIC ADMINISTRATION IN THE NETHERLANDS: EXPANSION,DIVERSIFICATION AND CONSOLIDATION

The rise of Dutch administrative sciences is related to the post‐war expansion of the country’s welfare state. The growing welfare state needed scientific support for policy‐making and planning. Legal expertise alone was no longer sufficient. After the initial separation from administrative law, the post‐war policy and administrative sciences in The Netherlands were strongly oriented towards our American ‘big brother’. Since the 1980s, a growing self‐identity and self‐confidence has developed. The period from the late 1970s to the mid 1990s witnessed a steady expansion and diversification of Dutch PA sciences. The subject is now taught at 11 of the 13 Dutch universities. The enormous growth of the early 1990s is over, and student numbers have now stabilized – and at a substantial level, thus consolidating the position of PA departments in most universities. From the mid 1990s onwards Dutch administrative sciences have gone through a process of internationalization. Dutch PA sciences have as a result acquired a status of recognized quality in the international scientific community.     

THE HISTORY OF GOVERNANCE IN THE NETHERLANDS: CONTINUITY AND EXCEPTIONS

THE HISTORY OF GOVERNANCE IN THE NETHERLANDS: CONTINUITY AND EXCEPTIONS
W.J.M. Kickert
Reed Elsevier, 2004, 121 pp., €17.85 (pb) ISBN: 9059014359     

PATIENT CHOICE IN HEALTHCARE IN ENGLAND AND SWEDEN: FROM QUASI‐MARKET AND BACK TO MARKET? A COMPARATIVE ANALYSIS OF FAILURE IN UNLEARNING

This paper compares elements of choice introduced under the market orientated reforms in health systems in the UK and Sweden in the 1990s, and the recent patient choice policy in both countries. It reviews empirical evidence on the impact of choice on users and services under these reforms to examine whether, and how far, these past developments have informed the current choice reforms. The paper asserts that the reappearance of issues and solutions in patient choice policy in the English NHS and in Sweden signifies limited learning from their own past and cross‐national experience, resulting in blurred and mutually exclusive policy agendas. The study argues that this absence of learning happens because of the seeming inability of governments and policy‐makers to unlearn effectively their preconceived ideas and schemas, pointing out the limitations of social learning theory in understanding health policy development.     

SIMILAR PROBLEMS,DIFFERENT SOLUTIONS: COMPARING REFUSE COLLECTION IN THE NETHERLANDS AND SPAIN

Because of differences in institutional arrangements, public service markets, and national traditions regarding government intervention, local public service provision can vary greatly. In this paper we compare the procedures adopted by the local governments of The Netherlands and Spain in arranging for the provision of solid waste collection. We find that Spain faces a problem of consolidation, opting more frequently to implement policies of privatization and cooperation, at the expense of competition. By contrast, The Netherlands, which has larger municipalities on average, resorts somewhat less to privatization and cooperation, and more to competition. Both options—cooperation and competition—have their merits when striving to strike a balance between transaction costs and scale economies. The choices made in organizational reform seem to be related to several factors, among which the nature of the political system and the size of municipalities appear to be relevant.     

POLICY DIFFERENCES WITHIN THE UNITED KINGDOM: THE CASE OF HOUSING POLICY IN NORTHERN IRELAND 1979–89

This article examines, through a case study of housing, the extent to which national housing policies under the Thatcher government were modified or deflected at the N. Ireland regional level. Three aspects of housing policy - housing expenditure, public sector rents and the 'right-to-buy' legislation are considered and the roles of key actors within the territorial community described. Although similarities with GB housing policy emerge, there is evidence of a distinctive regional approach. Factors which influenced a N. Ireland-specific policy approach are considered and the potential for variance in the future outlined.